Though the prevalence of Hepatitis B and C has declined, India still bears a high burden of viral hepatitis. In fact, according to the World Health Organization (WHO), an astounding 40 million people are chronically infected with Hepatitis B, and 6-12 million have chronic Hepatitis C. While Hepatitis A (HAV) is more prevalent among children, Hepatitis E (HEV) is the main culprit in endemic hepatitis and is responsible for most cases of acute liver failure in India.
Although effective drug treatments are now available for the early stages of hepatitis B and C, advanced liver disease associated with viral hepatitis remains associated with high mortality and represents a significant burden on healthcare systems. Furthermore, because chronic hepatitis B and C infections are asymptomatic, many people go undiagnosed and untreated, leading to advanced liver disease and complications.
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Long-term consequences such as cirrhosis and cancer, combined with high stigma, require urgent awareness and action. Early detection and widespread awareness are paramount to reducing the burden of this disease.
Types of viral hepatitis and routes of infection
Viral hepatitis is classified into five main types: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E. Each type has different characteristics, including how it is transmitted, symptoms, and potential outcomes.
* Hepatitis A and E are primarily transmitted through contaminated food and water. Hepatitis A usually goes away on its own, but Hepatitis E can be severe, especially in pregnant women.
* Hepatitis B and C are transmitted through blood and body fluids. These infections can become chronic and lead to serious liver diseases, including cirrhosis and cancer.
* Hepatitis D is unique in that it requires the presence of the hepatitis B virus to survive. If both viruses infect the liver at the same time, liver damage can be more severe.
Challenges in controlling viral hepatitis in IndiaIndia faces daunting challenges in combating viral hepatitis. Low awareness and understanding of the disease coupled with limited access to testing and diagnostic facilities, especially in rural areas, hinder early detection and treatment. The stigma surrounding hepatitis also prevents people from seeking treatment. Unsafe hygiene and medical practices, including reuse of medical equipment, contribute to the spread of the virus. Overcoming these hurdles requires a multi-pronged approach that includes intensified awareness campaigns, improved health infrastructure and strengthened surveillance systems.
Strategy for Control of Viral Hepatitis in India* Improve sanitation and hygiene: Prioritize investments in sanitation infrastructure, especially in rural areas. Promote hand hygiene practices and safe food handling.
* Safe water supply: Ensuring that all people have access to clean, safe drinking water, especially in areas prone to water-borne diseases.
* Universal Vaccination: Implement and enforce a policy of universal vaccination against Hepatitis B, especially for newborns.
* Blood Safety: Maintains strict blood testing and transfusion protocols to prevent the spread of Hepatitis B and C.
* Harm Reduction: Implement evidence-based harm reduction strategies for high-risk populations, such as needle exchange programs.
* Surveillance and data management: Establish a robust surveillance system to monitor the spread of hepatitis, identify trends, and inform response efforts.
* School health programs: Incorporate hepatitis education into school curricula to reach young people.
* Decentralized testing: Expanding access to hepatitis testing services, including in primary health care facilities.
* Affordable treatment: Ensure affordability and availability of antiviral drugs for chronic Hepatitis B and C.
* Vaccine development: Continued research into developing a Hepatitis C vaccine
India is grappling with a high burden of viral hepatitis due to factors such as poor hygiene, inadequate health infrastructure and low awareness. A multi-pronged approach is essential. For Hepatitis A and E, improved hygiene and sanitation are paramount. For Hepatitis B and C, thorough testing, vaccination and safe blood management are required. By combining these strategies and tailoring them to local needs, India can effectively fight this silent epidemic.
(Dr Arbinder Singh Soin, Chairman, Medanta Liver Transplant, Gurugram)
